ArticlesLong-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study
Introduction
Most reviews of risk factors for asthma recommend extended breastfeeding to reduce the probability of development of atopy and asthma in childhood. Although such a view is widely accepted and promoted, few investigators have adequately addressed the issue, and their results are conflicting.
In 1988, Kramer1 Proposed 12 criteria for studies in which the relation between breastfeeding and development of atopy and asthma are assessed (panel). He suggested that previous studies contained flaws in design or implementation, including selection of the study population, retrospective recall bias about feeding history, short duration of follow-up, inadequate definition of outcomes, and failure to consider confounding variables. Despite further studies, controversy persists. Some investigators have reported protection,2, 3, 4, 5, 6, 7 whereas others suggest an increased risk of allergy and asthma associated with breastfeeding.8, 9, 10, 11, 12
We have examined outcomes of asthma and atopy related to breastfeeding in a population-based birthcohort study of New Zealand children which fulfills the criteria shown in the panel. Our hypothesis was that breastfeeding would protect against development of atopy and asthma in childhood.
Section snippets
Participants
All 1661 live-born children delivered at Queen Mary Hospital, Dunedin, New Zealand, between April, 1972, and March, 1973, were included in a neonatal study.13 Children from this cohort who were resident in the province of Otago at age 3 years were invited to participate in the longitudinal Dunedin Multidisciplinary Health and Development Research Study. We enrolled 1037 (91%) of 1139 eligible children. Cohort families represented the full range of socioeconomic status in the general population
Results
Of 1037 children in the longitudinal study, 463 (45%) were not breastfed. In 70 (7%) children, breastfeeding was attempted but was discontinued before the child was 4 weeks old. Preliminary analyses showed that these 70 children had outcomes much the same as those who were not breastfed, and quite different to those breastfed for 4 weeks or longer. These 70 children were therefore included in the non-breastfed group, making a total of 533 children (51%). Mean duration of breastfeeding in the
Discussion
Our results provide substantial evidence against our initial hypothesis that breastfeeding is protective against atopy and asthma. By contrast, breastfeeding for 4 weeks or longer increased the likelihood of skin test responses to common allergens at age 13 years, and more than doubled the risk of diagnosed asthma in mid-childhood, with effects persisting into adulthood.
We investigated a large unselected population-based birth cohort, in which roughly equal numbers were breastfed and not
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2022, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Although the association between breastfeeding and asthma is an active area of research, there have been some inconsistencies in findings and gaps where further investigation is warranted. For example, some studies have found that breastfeeding is protective against asthma in children,10-13 whereas others have found increased14 or no association with asthma.15 These studies varied in study population, exposure assessment, asthma characterization, and age at assessment.